•Beliefs related to pain, stress, somatic hypervigilance, and fear disrupt motor control (Moseley et al 2004)
•People with chronic pain have reduced cognitive processing capacity due to emotional factors associated with pain (Durfton 1989)
•Improvement in psychomotor performance is associated with reduction in distress rather than a reduction in pain during functional restorative programmes (Luoto et al 1999)
•People who report catastrophic thinking processes are particular affected (Crombez et al 1997) by attentional interference during task performance although there was no difference reported in unpleasantness or intensity. Fear of pain had a similar affect.
•Pain interrupts the cognitive performance according to its threat value and the degree of emotional arousal with which it is associated (Eccleston & Crombez 1999)
•Any demand on CNS resources may plausible reduce motor performance as seen in reduction of normal standing balance (Marsh & Geel 2000), reduced speed and stability of walking (Ebersbach et al 1995) and reduced speed and increased error rate in hand-writing (Brown & Donnenwirth 1990)
•Stress : motor performance of postural muscles has been
shown to be reduced during repetitive arm movements whilst performing the Stroop test if negative feedback was given to the subjects (Moseley et al 2004)
•Supraspinal inputs can have an effect on sensory inputs that access the alpha-motoneuron (ie within the nociceptive components of the sensory system) or directly on the alpha motoneuron (Anderson 1996) whereby the latter mechanism allows the CNS to ‘prime’ certain motor pathways for sensory input. This has implications in people attempting movements which they expect to be painful.
•Investigations in chronic low back pain and orofacial pain reported elevated EMG activity levels associated with stress during static and dynamic tasks (Flor & Turk 1989, Flor et al 1992)
•This pattern is consistent with a ‘muscle tension model’ of chronic pain and has similarities with the ‘vicious cycle’ proposed by Simons & Travel (1942)
•Biofeedback has been demonstrated to reduce low back pain (Flor et al 1983), however the effect of biofeedback training was dependent upon the subjects perceived ability to reduce tension rather than their actual ability to reduce tension. This was replicated by others when reductions in pain intensity were correlated in improvement in self-efficacy measures (Blanchard et al 1982, Rokicki et al 1997). Therefore, these effects were cognitive rather than changes in muscle tension
•An alternative explanation may be the effect of intensive sustained somatic awareness on areas of the cortex affecting the ’internal body dynamic’, which has been shown to have substantial reorganisation associated with chronic low back pain (Flor et al 1997), which may mean that cortical representation in response to training, regardless of the training objective, may contribute to the therapeutic effect
•The pain adaptation model, stipulates that in the event of pain, the alteration in motor control stiffens the associated body segments (Lund et al 1991), which has been implicated in the development of chronicity (Main & Watson 1996)
•Flexion Relaxation Ratio (FRR) (Ahern et al 1988) vs Fear Avoidance Beliefs Questionnaire (FABQ) (Waddell et al 1993), vs Pain Self-Efficacy Questionnaire (PSEQ) (Nicholas et al 1992), vs the Oswestry Disability Questionnaire (ODQ) (Fairbank et al 1980), vs VAS pain intensity
–Correlation between FRR and FABQ
–No correlation between FRR and VAS and ODQ (Watson et al 1997)
•Cognitive Behavioural Programme
–Strong correlation between FRR and the change in PSEQ (r>0.45, P<0.03) and FABQ (r>-0.3, P<0.04)
–This provides compelling evidence regarding fear of re-injury and self perception on the ability to perform everyday tasks (Watson et al 1997)
•Fear of pain effects motor control depending upon the anatomical relevance of the impending pain (Flor & Turk 1989, Flor et al 1992, Vlaeyen et al 1999)
•During experimentally induced low back pain, the reactions of multifidus and transverse abdominis to repetitive arm movements was reduced mean amplitude and reduced coherence with arm movements (Hodges et al 2003)
•Robust alterations in thoracic to lumbar spine erector spinae ratios during gait in people with chronic low back pain has been demonstrated (Lamoth et al 2004) which was replicated in acute experimentally induced low back pain by injection of hypertonic saline solution and through random noxious electrical impulses generating fear related alterations in motor control
Conceptualisation of chronic pain and motor control
- Perceptuo-motor perspective
- The neuromatrix theory (Melzack 1989, 1990)
- The reality-virtual reality theory (Wall & Melzack 1999)
- The fear-avoidance model (Vlaeyen & Linton 2000)
The primary objective of assessment is to identify the factors which contribute to a sense of threat
•Cognitive
•Emotional
•Functional state of nociceptors
•Impact of psychosocial stressors on motor control
What We do
What We Treat
